Evaluation of Multi Drug Resistant Pseudomonas Aeruginosa Isolates in Chronic Suppurative Otitis Media.

Sankar, P (2007) Evaluation of Multi Drug Resistant Pseudomonas Aeruginosa Isolates in Chronic Suppurative Otitis Media. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Ear is the most important sensory organ concerned with the perception of hearing. Infections are the leading causes of deafness worldwide. CSOM is a chronic Suppurative inflammation of mucoperiosteal layer of the middle ear cleft (Plate1). Incidence of CSOM higher in developing than developed countries particularly in India. The global burden of illness from CSOM involutes 65-330 million individuals with draining ears, 60% of whom 38-200 million suffer from significant hearing impairment CSOM accounts for 28000 deaths and a disease burden of over 2 million disability adjusted life years. Over 90% of the burden is borne by countries in south East Asia (WHO 2004). It shows the importance of controlling the infections effectively by for preventing the hearing loss all over the world. In developed countries the incidence of CSOM had come down to 0.04% of all cases of suppurative otitis media. In a rural area of India it was found to be 4.26%. Chronic suppurative otitis media is considered to be major problem in developing countries with relatively high mortality and morbidity (Glass cock et al; 1990). Pseudomonas aeruginosa is an opportunist pathogen that can infect almost any body site given the right predisposing conditions. Pseudomonas aeruginosa is a significant pathogen among gramnegative organisms infecting ear (Brobby Gwetal ; 1987, Brook I et al., 1996). Infections caused by pseudomonas aeruginosa are often severe and life threatening and are difficult to treat because of the limited susceptibility to anti microbial agents. (Carmeli; Y; et al ; 1999). The problem of antibiotic resistance in Pseudomonas aeruginosa is on the increase. Accumulation of resistance after exposure to various antibiotics and cross-resistant among agents may result in multidrug resistant Pseudomonas aeruginosa. AIMS AND OBJECTIVES : a) Isolation of aerobic causative organisms from chronic suppurative otitis media. b) Identification of pseudomonas aeruginosa from chronic suppurative otitis meida and their characterization. c) Determination of minimum Inhibitory concentration of selected expanded 3rd and 4th generation, for pseudomonas aeruginosa isolation from CSOM. d) Detection of group I inducible β – Lactamase production by the test isolates and their prevalence. e) Detection of extended spectrum of β –Lactamases (ESBLs) producers among the pseudomonas aeruginosa isolates from CSOM and their prevalence. f) To evaluate synergy effects of selected antibiotics. g) Comparative study of Multidrug resistant between Pseudomonas aeruginosa and other isolates from CSOM. h) To isolate plasmids from CSOM strains of Multidrug resistant pseudomonas aeruginosa. MATERIALS AND METHODS : All the Ear Swab specimens obtained from CSOM patient were processed in the Department of microbiology Government medical college hospital Coimbatore, South India from October 2005 to September 2006 were considered for the study, A total of 43 Pseudomonas aeruginosa isolates from chronic suppurative otitis media patients were cultured and they were stored as suspensions in a 10% (wt/vol) skim milk solution (STGG medium) containing 10% (Vol / Vol) glycerol at 80ºC until additional tests were performed. The other swab was inoculated immediately to blood Agar, chocolate Agar, Macconkey Agar, Potato dextrose Agar, Cetrimide Agar and Brain heart infusion broth for bacteria isolation. "C" shaped streaks in a row were made with spatula while inoculating solid media in order to obtain inoculums in decreasing gradation. Inclusion Criteria: 1) Recurrent or persistent ear discharge over 2-6 wks through a perforation of tympanic membrane who had not received Topical or systemic antibiotic therapy for the previous five days. 2) Patients age ranged from 1 month to 80 years. Their pathogenic potential was confirmed by correlating with clinical findings and repeat isolations. Exclusion Criteria: 1. Acute otitis media, 2. Chronic otitis media with effusion, 3. Cases having purely sanguineous or CSF otorrhoea, 4. Antibiotic therapy (Topical or systemic) with in previous five days. RESULTS : During the study period from October 2005 to September 2006 a total of 110 Ear Swabs were collected from 100 Patients with CSOM attending ENT OP, Coimbatore Medical College hospital and Ear swabs were processed in the laboratory of microbiology department Coimbatore Medical College Hospital Coimbatore. Out of 100 patients with CSOM 10 patients were suffering from bilateral CSOM (Fig.1). About 114 Organisms were isolated from 110 specimens. Among 110 specimens 105 numbers showed positive cultures (95.45%) This study showed that most common isolates obtained from CSOM patients were pseudomonas aeruginosa (37.7%), Staphylococcus aureus (32.4%), Proteus sp (12.2%), Klebsiella sp (7.8%), Coagulate negative staphylococcus aureus (2.6%), Streptococcus pyogens (1.7%), E. Coli (0.8%), Moraxella catarrhalis (0.8%), Candida Sp (2.6%), Aspergillus (0.8%). In total of 105 positive cultures 9 cultures showed mixed growth. SUMMARY : 110 Specimens were collected from 100 CSOM patients attending ENT OP at Government Medical College Hospital, Coimbatore during October 2005 to September 2006. 43 strains of pseudomonas aeruginosa were collected during the study period. Antibiotic susceptibility testing was done for these strains by Kirby -Bauer disc diffusion method. MIC for all 43 strains were detected using Hicomb test (E-TEST). Antibiotic susceptibility of the strains were correlated with their MIC value. Inducibility of beta lactamases were detected for the 20 sensitive trains isolated, by double disc diffusion test and it was observed that all 20 strains were induced to produce betalactamases with disc approximation at 20 mm apart. Only 8 (40%) were induced to produce betalactamases when the discs were 25 mm apart. ESBLs were detected for the resistance strains by double disc diffusion test. Presence of ESBL was detected in 4.3 % strains through 20mm disc approximation, 34.7% of strains through 15mm of disc approximation, 78.2% through 10 mm disc approximation.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Multi Drug Resistant ; Pseudomonas ; Aeruginosa Isolates ; Chronic Suppurative Otitis Media.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 14 Aug 2017 06:09
Last Modified: 14 Aug 2017 06:09
URI: http://repository-tnmgrmu.ac.in/id/eprint/1444

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